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Adjunctive procedures to maximize the result of cosmetic eyelid surgery.

The cosmetic blepharoplasty should be complemented by surgical procedures that augment the favorable aesthetics of the blepharoplasty. A blepharoplasty is frequently not fully satisfying to the patient or the surgeon. The plastic surgeon must recognize the need for adjunctive procedures such as eyebrow lift, blepharocanthoplasty, malar implants, dermal abrasion, chemosurgery, and temporoauricular lift to fulfill the more ideal expectations of both surgeon and patient. Evaluation of the aesthetic requirements for youthful restoration around the eye and the need for additional surgical techniques to enhance the beauty of the eye is discussed. Included in the discussion are the techniques used for the various procedures, the complications that can arise, and the reward of surgery performed in conjunction with the routine blepharoplasty or instead of it.

Dermabrasion↗

Are the accessory facial movements of the stutterer learned behaviours?

The purpose of the present study was to explore the accessory nonverbal behaviours emitted by stutterers when their speech was fluent, normally disfluent, or stuttered. Subjects were 25 stutterers who were required to speak spontaneously for a 2-min. period. Seven types of nonverbal behavior were observed. Significant differences among the three speech categories were obtained for jaw movements, mouth movements, forehead movements, eyebrow movements, and head movements. Eyelid movements and eye blinks were nonsignificant. The results are discussed with respect to the various functions that can be attributed to nonverbal behaviour in stuttering.

Adolescent↗

Surgical experience with frontolateral keyhole craniotomy through a superciliary skin incision.

OBJECTIVE: The purpose of this study was to evaluate the results of 173 frontolateral keyhole minicraniotomies performed on 155 patients with aneurysms of the anterior or posterior cerebral circulation and for supratentorial tumors. METHODS: The frontolateral keyhole craniotomy is a modification of the generally used pterional approach. Of the 155 patients studied, 102 harbored saccular arterial aneurysms in the vessels of the anterior or posterior cerebral circulation, and 53 had various tumors in the frontal base, suprasellar, or parasellar region. The operations were carried out through an approximately 2.5- x 3-cm frontolateral miniaturized craniotomy after a skin incision just above the eyebrow. RESULTS: Despite the small size of the craniotomy, the exploration allows enough room for intracranial manipulation with maximal protection of the brain and other intracranial structures. The presented series of patients did not have any craniotomy-related complications. CONCLUSION: In our experience, the frontolateral keyhole craniotomy, together with the advent of the modern neuroanesthesia, cerebrospinal fluid drainage, and microsurgical techniques, is a safe approach for an experienced neurosurgeon to use in the treatment of supratentorial aneurysms or tumors of the anterior fossa and sellar regions.

Brain Neoplasms↗

Acquired ciliary circumscribed grey hair (ACCG).

Grey-haired areas usually occur due to aging or inheritance. A case is described of abrupt occurrence of a focal circumscribed grey-hair in the eyebrow region (a single hair) in a 27-year-old woman. The phenomenon was named acquired ciliary circumscribed grey-hair (ACCG). Qualitative and semiquantitative findings were obtained by microanalytical studies. In addition to morphological differences from control hair, the ACCG hair showed a high percentage of sulfur (99.8%) and absence of oligoelements.

Adult↗

Dermoid cysts in children.

A retrospective study of dermoid cysts in children over the past 13 years at St. Christopher's Children's Hospital of Philadelphia, showed that 37% of the dermoids in the body occurred in the orbital and peri-orbital areas. An unusually high percentage of these occurred in the left eyebrow which appears to be the most frequent location for dermoid cysts in children. Dermoid cysts are a very common lesion encountered by ophthalmologists inasmuch as 3.3% of all ophthalmic surgical procedures in children were performed for dermoids. All 231 cases in this series were benign. The manner and time of presentation of these lesions are discussed as well as the treatment.

Adolescent↗

[Forum: dermopigmentation or medical tattooing. Dermography in cancerology. Apropos of 220 clinical cases].

Based on a series of 220 cases of reconstruction (63 cases) or correction (67 cases) of the nipple-areolar complex and various extramammary procedures (tattoo scar revision, lips, eyebrows, eyelashes) (90 cases), the authors present their 2-year experience of medical dermography in a cancer centre. Dermography allows breast reconstruction to be completed in a large number of patients who had initially refused to complete their reconstruction. This minimally aggressive outpatient technique which reconstitutes the areolo-nipple complex with sufficient quality, is now part of reconstruction protocols and is gradually replacing surgical techniques.

Breast Neoplasms↗

WAARDENBURG'S SYNDROME AND HETEROCHROMIA IRIDUM IN A DEAF SCHOOL POPULATION.

Waardenburg's syndrome consists of lateral displacement of the inner canthi of the eyes (dystopia canthorum), a broad nasal root and confluent eyebrows, heterochromia iridum, a white forelock and congenital deafness. The syndrome is inherited as a dominant, but affected individuals do not necessarily have all of the characteristics cited.Five hundred and fourteen pupils at a school for the deaf were screened for features of this syndrome. Three cases were discovered. Eleven other deaf children were found to have heterochromia iridum and two more had white forelocks. The interocular dimensions of the remaining children were recorded as standards by which to judge the presence of dystopia canthorum. The results of chromosomal analysis in two cases with Waardenburg's syndrome were normal.The findings provide further evidence that Waardenburg's syndrome is a distinct entity and call in question Mackenzie's concept of a comprehensive "first arch syndrome".

Adolescent↗

Endoscopic aesthetic facial surgery: technique and results.

The endoscopic approach to forehead and midface lifting has become popular method of face rejuvenation with minimal incisions. We have performed 67 endoscopic facelift procedures in the last four years. Forehead lifting technique included five small scalp incisions, wide subperiosteal elevation, endoscopic myotomy and forehead tissue fixation with srews, superficial temporal fascia (STF) suture to deep temporal fascia (DTF). Midface lifting technique included temporal 2.5 cm and 1.5 cm vertical intraoral incision, midface subperiosteal undermining and midface elevation with cable sutures Bichat's fat to DTF. Age mediana of patients who underwent endoscopic front lift was 46, patients who had endoscopic front lift and midface lift procedure age mediana was 40. Postoperative complication rate was 7.5% and included frontal branch weakness (n=2), hematoma (n=1), infraorbital nerve paresthesia (n=1) and asymmetrical smile (n=1). The main question is the quality of the results. We have reviewed 49 patients who were followed 6 months or more. Preoperative and postoperative life-size photographs were analyzed. The mean elevation mediana at medial canthus was 2.2 mm, at medial limbus 2.3 mm, at lateral limbus 2.5 mm, at lateral canthus 2.9 mm. Midface - lift effect resulted cheek elevation from 1.07 till 4.71 mm lip corner elevation 1.03 mm to 3.27 mm. We observed cheek elevation, improving nasolabial line, increasing volume of malar region, elevating lip angles in patients after endoscopic midface lift. We have found that important advantage of subperiosteal midface lift, when performed in conjunction with endoscopic brow lift, is its ability to move the cosmetic eye unit, proportionally, leading to a harmonious facial appearance. Endoscopic facelift is effective procedure for face rejuvenation especially for eyebrows and cheek elevation.

Adult↗

Frontal fibrosing alopecia.

A 75-year-old woman presented with a 3-year history of progressive loss of her eyebrow hair and with frontal-parietal hairline recession. Multiple biopsy specimens supported a histopathologic diagnosis of lichen planopilaris. With these histolopathologic findings, and the patient's clinical presentation, a diagnosis of frontal fibrosing alopecia was made. Treatment to date with topical glucocorticoid preparations, intralesional triamcinolone injections, and tacrolimus ointment have been unsuccessful.

Aged↗

Secondary syphilis clinically mimicking pseudolymphoma of the face.

Syphilis has been given titles such as the great imitator, the great mimic, and the great masquerader. It may lack pathognomonic signs and often presents similar to many other dermatological conditions. We present a case of a young woman who developed asymptomatic papulonodular lesions on the forehead; the lesions were clinically similar to pseudolymphoma but it was determined that she had secondary syphilis exhibiting prozone phenomenon. She also had alopecia of eyebrows. Both the alopecia as well as nodular lesions clinically resembling pseudolymphoma responded to and completely recovered with antisyphilitic treatment.

Adult↗

Eyelid tattooing.

Tattooing has recently regained popularity in medicine. Cosmetic blepharopigmentation for eyelid enhancement by permanent eyeliner has received considerable attention. In addition, permanent pigmentation has been used for eyebrow simulation, camouflaging of scars, nipple areolar pigmentation following breast reconstruction, and the management of several other pigment disorders. This article emphasizes the principles and technique of blepharopigmentation.

Burns↗

[Facial hair in the context of biology].

The subject of the variation in facial hair has been somewhat neglected but lies somewhere between dermatology, anthropology and anatomy. Eyelashes, eyebrows, beards, and nose and ear hair show marked ethnic variation. A particular role is played by the variety of kinds of ear hair in Indian and Sinhalese populations.

Biological Evolution↗

[Distribution of morphologic traits and ability to taste PTC in Northern Greek populations].

Four qualitative morphological traits (relative finger length, hypertrichosis of external ear, association of the eyebrows, cheek-dimples) and the ability to taste PTC have been studied in a total of 7831 males and females from Thessaloniki and its surroundings. This sample is representative for the population of Northern Greece. The distribution of all these five parameters is showing more or less marked sex differences. The frequencies found in the Greek sample are compared with those reported for other populations.

Adult↗

Burn injuries of the eyelids.

Burns of the eyelid and surrounding structures are relatively uncommon in spite of a high incidence of thermal injuries involving the face. The etiologic factors, circumstances that precipitated the injury, and the anatomical features unique to the eyelid and adnexal area may conceivably account for the low incidence. The basic aims in reconstructing deformities must include primarily measures of protecting corneal exposure and relieving epiphora. Early reconstruction of other deformities such as epicanthal folds, palpebral stenosis, and missing eyebrows and eyelashes should be discouraged because of frequent recurrence of deformities due to contracting scars and scar hypertrophy.

Adult↗

Correction of the ptotic brow.

Aesthetic considerations of the eyebrow are reviewed. It is imperative that the aesthetic surgeon be aware of the importance of brow shape and position as they relate to the appearance of the upper face and eyes. The surgeon must diagnose brow ptosis and correct it appropriately. The variations in approach in men and women are outlined.

Esthetics↗

[Lateral fat in upper blepharoplasty].

"The eyebrow fat pad" was described by Charpy in 1909 without raising the interest of plastic surgeons. Over the last 5 years, we have removed this fat in 20% of our cases of superior blepharoplasty. This technique allows a reduction of the thickness of the upper eyelid to a lesser degree than that obtained by bone remodelling. We present the operating technique illustrated by clinical examples.

Esthetics↗